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Ontario’s doctors vote Sunday to either accept or reject a controversial contract proposal.

At stake in the Ontario Medical Association ballot is a tentative four-year agreement struck with Ministry of Health in early July.

But since the deal was reached, cracks within Ontario’s physician community have emerged, with a group of doctors upset with the deal dubbing themselves Concerned Doctors of Ontario and fighting for a no vote.

OMA president Dr. Virginia Walley told the Toronto Sun last week that accepting the deal will provide stability in the health-care system and for doctors.

“Physicians haven’t been involved in decision-making on the part of patient over the period of the last couple of years,” she said of the time since the doctors had a deal with the province. “These are important things that this agreement remedies.”

Walley also said the deal does not surrender the doctors’ pursuit of binding arbitration over contracts with the government. The agreement leaves the OMA’s court challenge for arbitration intact.

In fact, the agreement proposes doctors co-manage the $11.5 billion physicians services budget with the government. It includes a third-party facilitator to help iron out disagreements between the parties, she said, likening it to “an element of binding arbitration.”

“We recognize how important it is to reach agreements when we have disputes with the government around aspects of what we consider in the best interests of patients,” she said.

Dr. Scott Wooder, past OMA president and part of the group that bargained the deal with the province, said this agreement will give doctors an “equal say” in how their budget is managed. Without an agreement, the OMA anticipates “permanent cuts of up to $1.1 billion over the four years,” he said.

“We’re confident we can find savings in the schedule of benefits that won’t have an impact on patient care,” Wooder said. “We can identify things that we do now, that don’t add value to patient to care and we’re confident that it’s better that we do this with our members involved than letting the government do it on their own.”

Wooder called expectations that the agreement should try to undo past under-funding of the system unrealistic.

“I heard some people want to go back to 1970 to address that,” he said. “It’s not realistic in these economic times in Ontario or anywhere else in Canada to think we’re going to back and address funding problems that stretch back over decades.”

Dr. Nadia Alam, co-leader of Concerned Ontario Doctors, told the Sun this week that physicians will lose $1 to 2 billion over the next four years under the new deal. That translates to anywhere from $35,000 to $70,000 per physician. Smaller clinics forced to deal with the cuts may close, she said.

“That means less care for everybody,” she said. “If those physicians aren’t working that’s thousands of patients that are not being seen.”

Alam said the six-page tentative agreement is too vague and leaves management of the physician budget to the government and OMA, in whom many in Ontario’s physician community have lost trust.

“Working with this government is not going to be easy,” she said. “There is no equal ground here. There is no collaboration. There is no way for physicians to be able to protect their practices and their ability to provide patient care.”

Alam said the agreement also effectively surrenders to the government’s unilateral cuts of January 2015. It engrains the status quo without addressing underfunding in the system that has existed for years, she said.

“The status quo sucks,” she said. “It doesn’t serve patients well. It barely puts out fires. It doesn’t improve chronic disease or preventative care in any way. I don’t want the government to maintain the status quo. I want the government to improve the system.”